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Médecine et chirurgie du pied

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Comparative Study of the Interest of the Arthroscopy in the Conservative Treatment of the Hallux Rigidus: about 39 Cases Volume 37, issue 4, Décembre 2021

Tables


  • Tableau 1

  • Tableau 2

  • Tableau 3
Authors

Introduction

Hallux rigidus (HR) is a painful degenerative disease of the first metatarsophalangeal joint with reduced mobility and function. Several surgical techniques have been described in the literature. The first metatarsophalangeal arthroscopy (MTP1), used alone or in combination with osteotomies, has been the subject of numerous technical descriptions but few comparative studies. The aim of this study is to demonstrate the interest of arthroscopy in the treatment of HR.

Materials and methods

In a retrospective study of 35 patients (39 HR) treated between 2014 and 2017, we compared the results of arthroscopic treatment versus percutaneous technique by analyzing the results on foot function. The age, sex, clinical signs, and mobility of MTP1 were collected. The Coughlin and Shurnas classification were used to determine the severity of the RH. The clinical results were evaluated by the AOFAS score.

Results

Our population was divided into two groups: 21 HR treated by arthroscopy (G1) and 18 operated by percutaneous surgery (G2). The two groups were homogeneous. Preoperatively, the average mobility of MTP1 in G1 was 38.9° for dorsal flexion (FD) and 12.7° for plantar flexion (FP). The mean preoperative mobility of MTP1 in G2 was 34° for FD and 10.5° for FP. At the last follow-up (17.7 months for G1 and 37.5 months for G2), active mobility was around 78° FD for G1 against 65° for G2. The average passive mobilities were 87° FD and 73° FD, respectively, for G1 and G2. The FP was higher in the G1 with 17° against only 11° for the G2. The maximum improvement was noted within three months for G1, and between three and six months for the second group. The mean AOFAS score calculated preoperatively was 42 and 45, respectively, for groups 1 and 2. At the last follow-up, the score was 88 for G1 against 75 for G2.

Discussion

The HR can be managed by open surgery, percutaneous, or arthroscopy. To allow rapid recovery and minimize the complications of open surgery, percutaneous surgery and arthroscopically assisted surgery have been used more and more often. The purpose of arthroscopy is to perform debridement, synovectomy, pruning, or cheilectomy, to remove particles, but above all, to assess and treat osteochondral anomalies. Stages I and II were the best indications. Stage III may be an indication for the use of the arthroscope if there is some degrees of mobility. In our series, arthroscopy treatment was combined with percutaneous treatment in order to correct the bone anomalies observed clinically and on the preoperative radiological assessment, such as the metatarsus elevatus. This combined treatment also makes it possible to recover better FD. Concerning patient satisfaction, we compared the AOFAS scores published for the different techniques. Treatment by simple arthroscopy seems to give the best AOFAS scores, which testifies to the superiority of this technique.

Conclusion

Our results confirm the superiority of arthroscopic treatment. The postoperative consequences, the recovery rate, and the functional scores are better in the short- and medium-term. It is an evolving pathology, and the literature does not have enough perspective to assess and compare the results of these different techniques.